DISCUSSION FORUM TBI

Medical BG
These are the important consideration regarding the patient’s medical condition prior to any
examination procedures and intervention to be done to the traumatic brain injury (TBI) patient:
 Patient’s possible comorbidities are as physical therapists, we must be aware of the
potential risk factors that contribute to a patient's traumatic brain injury (TBI). Patient
accidents, brain contusions, and concussions, among other things, can cause it. To be
able to have a detailed course of treatment, a physical therapist must be aware of the
potential reasons.
 The age of the patient should still be taken into account. Some older people are unable
to handle such medications in such a manner that they have no adverse effects on the
patient. Any of the physical therapist's treatments or procedures could be unsafe for the
patient due to his or her age. The epidemiology of traumatic brain injury also shows that
most men are most likely to have experience traumatic brain injury or TBI.
 The glassgow coma scale is an outcome measure which is very much important to
take in to consideration. It is done to take note of the consciousness and awareness level
of the patient right after the accident. It is important in a way that it helps other therapists
to provide an appropriate plan of care and or the rehabilitation plot of the patient.
 For the patient’s medication, another thing to keep in mind is that a patient's
medications can have side effects that prevent treatment treatments from being
performed on the patient. Patients of traumatic brain injury (TBI) are not permitted to take
some of such medications. The physical therapist must be aware of the medications that
the traumatic brain injury (TBI) patient is taking.
 In the patient’s family medical history, it should also be taken in to consideration, that
patient’s parents might be positive for having diabetes mellitus. With this, it might impede
the healing process of the patient’s surgical wound.
Subjective assessment
The following underneath are the other important information that should be included in the
subjective assessment part of the initial evaluation or IE:
 How high is the slope that the patient jumped off? - it is important to know how high
the slope was. The particular reason for the circumstance is that there might be other
injuries aside from the traumatic brain injury he acquired upon landing from the slope.
There might be presence of closed fractures, internal bleeding, and or organ
displacements.
 Does the patient acquired any neck problems? - it is important to know whether the
patient has any neck problems. It might contribute to the patient’s illness. Even if he
wears helmet on the head, the neck might be affected as well from the high and strong
impact from the fall and rolling upon landing from the slope.
 Is the patient wearing a fully geared uniform? Does it include elbow and knee pads? -
it is important in a way that it will somehow lessen the impact upon landing from the
slope. It will also prevent the patient to acquire scratches and other wounds when he roll
down the slope.
 Is the training ground having a medical team ready to respond whenever accidents
happens? Is there an ambulance present in the training grounds? - it is important
because the time of responding to the accident matters. Since it is an emergency, then
the rightful medical actions should quickly be done to the patient.
 An x-ray should be done to the patient. It is important to know whenever the patient
breaks any of his bone at any part of the body. It is to call out the attention of orthopedic
doctors to aid the fractures that the patient acquires. Whenever there are any findings of
fractures or dislocation upon the results of the x-ray diagnosis.
Objective assessment
In objective assessment, the therapist will be assessing the patient through various tests and
measures. It is important because it can be a basis for the foregoing plan of care of the
physical therapist to the patient who complains of any abnormalities or irregularities.
Hereunder are the other patient objective assessment wherein not included in the presented
IE or initial evaluation:
 Functional independence measure for adults (FIM) - The physical, psychiatric, and
social functioning of a patient is assessed using this diagnostic process. The patient is
required to perform basic activities of daily life and instrumental activities of daily living
(B/IADLs) such as feeding, bathing, and a variety of other tasks. This tool assesses a
person's ability, especially the patient's cognitive capacity.
 Test for patient’s coordination - this is important to be conducted to rule out any
cerebellar lesion upon the impact of the fall from a high jump. Finger to nose can be
done to test the coordination of the upper extremity and heel to shin and to knee can be
done to test the lower extremities’ coordination. It is also used to determine how severe
the traumatic brain injury is.
 Berg balance scale - This approach is used to assess the patient's balance while
they're doing activities. The patient is told to play a certain task for a set amount of time.
To perform a sitting to standing intervention, the berg balance scale may be used. Before
returning to his or her seated spot, the patient must stand for several seconds and
maintain the pose.I f a patient fails to complete the required time or requires an assistive
device, a point may be removed. This examination will determine how well the patient will
perform his tasks, as well as the activities and interventions that must be completed.
Plan of care
Hereunder are the other PT treatment strategies or interventions for a patient with traumatic
brain injury:
 Balance and postural control training - it is important to conduct balance training and
as well as postural control training for the exact purpose of improving the patient’s
impaired balance and faulty posture. Weight shifting exercises can be used to train the
vestibular function of the patient’s body. Mid line orientation of the patient’s body is also
helpful to correct and improve the patient’s faulty posture. The mid line orientation
activities are done during transfers, side lying, and or sitting position. (Treatment
Parameters: weight shifting exercises x 10 mins & mid line orientation activities during
transfers, side lying, and sitting x 15 mins)
 Functional electrical stimulation (FES) - it is important to do functional electrical
stimulation (FES) to traumatic brain injury (TBI) patients the particular reason for this
circumstance is to stimulate muscle contraction and to re-educate the muscle for its
function or action. This actively demonstrates that the application of electrical current to
excitable tissue in neurologically damaged muscles in order to enhance or replace
functions that have been disabled. This is also good in generating repetition of muscle
movements and by supporting the quality of movements. (Treatment Parameters:
functional electrical stimulation (FES) x 20 mins)
 Bed mobility exercises - it is important to do bed mobility exercises to the traumatic
brain injury (TBI) patients to avoid muscle atrophy and also to avoid vascular diseases
which may be the causation of the appearance of pressure or bed sores. This will help
the patient to at least improve the muscle performance. (Treatment Parameters: straight
leg raises (SLR) x 10 reps x 1 set & ankle pumps x 10 reps x 1 set and progress as
tolerated)